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Could a psychological boost shake off back pain?

Each year, one in three people will have back pain. For over half of these, where no specific physical cause is found, back pain will probably resolve with some simple steps like exercise. But when back pain won’t shift and becomes long-term, your daily life can be affected.

It’s known that exercise, physiotherapy and medications can all help relieve back pain. But interestingly, growing evidence shows an association between pain and our thoughts and emotions. So could this link offer another way to help tackle back pain?

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  • What is back pain? What is back pain?

    Exercises for low back pain by Bupa UKPain is a warning signal. It’s designed to prevent injury.

    Back pain can be caused by tension, soreness and stiffness. Your back contains joints, the discs of your spine and other tissues, all of which can be the source of pain. At its worst, back pain can stop you working, doing the activities you enjoy and sleeping well. And it can also be an emotional drain.

    The way that pain feels to you depends on many things. Your pain is influenced by your attention, your beliefs about pain, whether you expect it and how you react to it. You may have noticed that your pain can feel worse if you focus on it or feel negatively about it.








  • The link between pain and emotion The link between pain and emotion

    Research has shown that pain and emotion can be linked, for example in gastrointestinal disease. Chronic (long-term) pain and emotions appear to be connected to the same nerve network in the brain, suggesting that they may influence each other.

    If you’ve had ongoing pain, you’ll know that it doesn’t only affect you physically, but can upset your mood too. For example, it may leave you feeling frustrated, anxious or depressed.

    It seems to work the other way too – your emotions can affect the way you perceive pain. Negative emotions can amplify pain and heighten the impact it has on your life. For some people, emotions can even cause pain, such as backache triggered by distress.

    So the link between pain and emotions can work in both directions. It can also cause a cycle, making back pain harder to shake off. Let’s take an example to see this in action. If you have a sore back, you might be anxious about it and avoid certain activities because you’re worried they will make it worse. But in reality, this could have the opposite effect. If your back muscles are weak or stiff, the right exercise will actually help you get better.

    The good news is, there’s a way to break the cycle.

  • Using psychology to boost recovery Using psychology to boost recovery

    Learning how to rethink your pain could be just what you need to help relieve it. If you’re happier and feeling more positive, you may have less pain and cope with it better too.

    There are many ways you can add a psychological approach to your pain management. Some simple steps you could take are:

    • getting tips about how to manage your back pain
    • learning techniques to relax and improve your sleep quality (see our Healthy mind and Sleep topics)

    Your GP will be able to advise you about other options that may be suitable to help with your back pain. These could include:

    • physiotherapy with a specialist who includes psychology theory in their treatment
    • attending a back clinic or pain management programme that includes psychological and behavioural tips on coping with pain and getting active
    • undertaking a course of psychosocial therapy, such as cognitive behavioural therapy (CBT) or mindfulness

    Accepting that there might not be a quick fix to your back pain can be a weight off your shoulders. Believing in the ability of your treatment to help you – and your ability to help yourself – can make a real difference.

    That’s not to say back pain isn’t a tricky problem to fix – it can be! That’s why it may take a number of different approaches to manage your pain effectively and enable you to enjoy life to the full.

  • Take control of your health

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  • The benefits of psychological therapy The benefits of psychological therapy

    If you worry a lot about your pain and feel it may never get better, psychological therapy may be particularly helpful for you. One type is cognitive behavioural therapy (CBT). This can help you to understand your thoughts, feelings and actions. Through techniques you will learn, you can alter the way you react to and cope with things, such as pain.

    Psychological therapy won’t necessarily make your low back pain go away. However, it may make it less intense, and help you get back to work and doing your daily activities. A pain management programme may have similar benefits.

  • Finding an approach to suit you Finding an approach to suit you

    If you’re interested in adding a psychological approach to your pain management, speak to your GP. They can advise you on what’s available and suitable for you.

    You can also use our Finder tool to search for a psychotherapist in your area. Many therapists now have specific expertise in providing cognitive behavioural therapy (CBT) to help manage physical symptoms.

  • Resources Resources

    Further information


    • Low back pain: early management of persistent non-specific low back pain. National Institute for Health and Care Excellence (NICE), 2009.
    • Hill JC, Whitehurst DGT, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 2011; 378:1560–71. doi:10.1016/S0140-6736(11)60937-9
    • The Chartered Society of Physiotherapy. Chronic pain., published July 2014
    • Watkin H. Back pain – an integrated approach in primary care. Acupunct Med 2004; 22:203–6.
    • Linton SJ, Shaw, WS. Impact of psychological factors in the experience of pain. Phys Ther 2011; 91:700–11. doi:10.2522/ptj.20100330
    • Therapy-related issues: central nervous system. Oxford handbook of clinical pharmacy (online). Oxford Medicine Online., published January 2012
    • Kikuchi S. New concept for backache: biopsychosocial pain syndrome. Eur Spine J 2008; 17 Suppl 4:421–7. doi:10.1007/s00586-008-0747-1
    • Jones MP, Dilley JB, Drossman D, et al. Brain–gut connections in functional GI disorders: anatomic and physiologic relationships. Neurogastroenterol Motil 2006; 18(2):91–103. doi:10.1111/j.1365-2982.2005.00730.x/pdf
    • Low back pain: patient information. National Institute for Health and Care Excellence (NICE), 2009.
    • Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4: European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15 (Suppl. 2):S192–S300. doi:10.1007/s00586-006-1072-1
    • Cramer H, Haller H, Lauche R, et al. Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complementary and Alternative Medicine 2012; 12:162:1–8.
    • STarT Back screening too website. Keele University., accessed 23 September 2014.
    • Psychotherapy. Oxford handbook of psychiatry (online). Oxford Medicine Online., published March 2013
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